Provider Demographics
NPI:1205645975
Name:ROBERSON, MALACHI K
Entity type:Individual
Prefix:
First Name:MALACHI
Middle Name:K
Last Name:ROBERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 BULLSKIN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-5434
Mailing Address - Country:US
Mailing Address - Phone:304-616-0997
Mailing Address - Fax:304-245-6125
Practice Address - Street 1:84 BULLSKIN ST
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-5434
Practice Address - Country:US
Practice Address - Phone:304-616-0997
Practice Address - Fax:304-245-6125
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician